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OPTUM API DEVELOPER PORTAL
Quick Start
Readme
Get Started with Optum APIs
API Onboarding
Security and Authorization V2
API Request Header
Generate an API Token
API Example
API Environments
Create a Sandbox Account
Access Sandbox Examples
Access our APIs
API URLs
Use the Try It Interface
HTTP Response Codes
Sandbox Predefined Fields and Values
Sandbox API Values and Test Responses
Use Test Payers in Sandbox
Use Test API Response Types
Use the Test Payer Accounts for each Attachments API Response Type
TESTEP01 Successful Attachments Transaction
TESTEP02 Transaction Accepted by the Clearinghouse
TESTEP04 Successful Receipt of Attachment by Payer
TESTEP05 Acknowledge Attachment Receipt by Payer
TESTEP06 Acceptance of Attachment by Payer
TESTEP10 Partial Acceptance of Multiple Attachments
TESTPP19 Payer Accepted with Errors
TESTEP51 Rejection of Attachments Transaction by the Clearinghouse
TESTEP52 Rejection of Attachment by Payer
TESTEP53 Rejection of Attachment Due to Request Validation Error
TESTPP11 Successful Fax Transmission
TESTPP12 Rejected/Failed Fax Transmissions
TESTPP13 Successful Fax Transmission
TESTPP14 Failures to Fax Transmission
TESTPP15 Failed Mail Attachments
TESTPP16 Mailed Attachments
TESTPP17 Track Information for Sent Transactions
TESTPP18 Track Information for Sent Transactions
Understand Transaction Details
API Health Check
API Example
Troubleshoot APIs with Metadata
Metadata Search Feature
Metadata Search Request & Response
Glossary
Quick Reference
API RELEASE NOTES
API Release Notes
API WORKFLOW
Attachments Workflow and Best Practice
Claims API Best Practices and Workflow
Claims Submission Workflow
Claims Rejected or Denied Workflow
Claim Processing and Reporting Workflow
Eligibility API Best Practices and Workflow
OPTUM API IMPLEMENTATION
Generate a Client SDK
ERROR MESSAGES
Overview
AAA Error Codes Requests and Possible Resolutions
Attachments Submission Error Messages
DNS Error
Eligibility Error Messages
Eligibility API: Unable to Process the Request at this Time
Error X-CHC-MN-Attachments-Payer Field is Mandatory
406 Error when running Auth Token Example
HTTP Error Response Codes
If Search Does not Show a Specific Record
Institutional Claims Error Messages
Invalid Access Token Error in Sandbox
79 (Invalid Participant Identification) Error
NPI Error
Other Payer Primary ID is Missing or Invalid
Patient Account Number Validation Error
Patient Eligibility not Found with Entity
Professional Claims Error Messages
Validation Endpoint Issue
FREQUENTLY ASKED QUESTIONS
FAQs
API Troubleshooting Tips
Security and Authorization FAQs
Batch File Formats Supported
ConnectCenter FAQs
File Types Supported
Process after completing Providers' EDI Enrollment
Sandbox FAQs
What is a tradingPartnerServiceId?
MEDICAL NETWORK ELIGIBILITY V3
Eligibility V3 Getting Started
Request Body Parameters
Use “Bare Minimum” Eligibility Requests
Response Body Contents
Required Fields in ISA06 and ISA08
X12 EDI 270 Request & 271 Response
Benefits Information Codes
Rejections with Known Good File
Eligibility JSON-to-EDI API Contents
API Example Eligibility
Request and Response
Eligibility API Tips
Allowed Time Qualifier Reference
Request with Known tradingPartnerServiceId
Request_HTML.aspx Endpoint
Response for Medicare Patient
Co-Insurance
Co-Payment
Find Deductible and Co-pay in Eligibility Response
How to Determine Co-pay without a Card
Interpret Service Level Information from Sandbox Response
Map X12 to CPT and/or ICD-10 Codes
Possible InsuranceTypeCodes
Set Up SFTP
Subscriber without an Active Medical Coverage
Search Options to Optimize Queries
Search an Eligibility Request by Transaction ID
Use ServiceType Codes to Identify Business Group
Without Active Coverage (Subscriber) from a Medical Plan
When to use Dependent Object
Eligibility FAQs
MEDICAL NETWORK PROFESSIONAL CLAIMS V3
Professional Claims V3 Getting Started
Use the Professional Claims V3 API
Request Body Parameters
Response Contents - Professional Claims
Professional Claims JSON-to-EDI Contents
API Example Professional Claims
Request and Response
CMS1500/UB04 Claims Forms
Test Production Data without Submitting for Processing
Test Prof. and Inst. Claims for PatientControlNumber
Test Rejected/Denied Claim
Render Provider in Loop 2310B
Resubmit a Denied Claim
Test different Professional Claims Validation and Submission Responses
Professional Claims FAQs
MEDICAL NETWORK INSTITUTIONAL CLAIMS V1
Institutional Claims V1 Getting Started
Request and Response Body
Institutional Claims API JSON-to-EDI Contents
API Example Institutional Claims
Request and Response
Create an EDI 837p 5010 Claim for a Client-Primary and Secondary Insurances
ClaimReference Field in Submission Response
Corrected Claim in Appeals and Denials
Handle multiple authorization numbers per claim
Send an EOB from the Primary Payer with the Claim
RAW-12 Validation Requests & Responses
Test Production Data without Submitting for Processing
Test Claims in Sandbox
Test Prof. and Inst. Claims for PatientControlNumber in Sandbox
Test Rejected/Denied Claim
Use Conditional Codes in Institutional Claims
Use Claim Filing Indicator Code
Submit Claim with Remarks
Institutional Claims FAQs
MEDICAL NETWORK CLAIM STATUS V2
Claim Status V2 API Getting Started
Request Body Parameters
Response Contents
Claim Status API JSON-to-EDI Contents
API Example Claim Status
Request and Response
Single 277 Claim Status Response
Retrieve Specific Claim Status
Manage Adjustment Codes from Payer in Claim Status API
Use STC Codes
Claim Status FAQs
MEDICAL NETWORK ATTACHMENTS RETRIEVAL V1
Attachments Retrieval V1 Getting Started
Attachments Retrieval JSON-to-EDI API Contents
Attachments Retrieval FAQs
API Example Attachments Retrieval API
MEDICAL NETWORK ATTACHMENTS SUBMISSION V1 API
Attachments Submission V1 Getting Started
Standard Attachment Transaction StatusCode Responses
Associating Attachment Submissions to a Claim
Attachment Submission API Use Cases and Results
Attachment Submissions API JSON-to-EDI Contents
Optum Batch Attachment Electronic Interchange Companion Guide
API Example Attachments Submission
Request and Response from Payer
Attach Multiple Files to a Transaction
Attachments JSON-to-EDI Map in a Request
Check Attachments Submission Status
Find a Specific Attachments Transaction
JSON Fields versus X12 EDI Loop Associated with a Field in 275 in an Attachments Request
Solicited Attachments Transaction
Remediate Attachments Transaction Issues
Send Fax Numbers to Payer
Successful Attachments Transaction Response
Solicited Attachments Response to a 277R Transaction
Query Specific Attachments Transaction
Payer Submissions with unsupported 275 Transactions and that do not accept Faxes
Physical Mail Packet to Payer
Unsolicited Attachments Transaction
Unsolicited Attachments for a 275 Claims Transaction
Test Payer Accounts for each Attachments API Response Type
Timeline for Validation and Submission Updates
Use Fieldset Argument in your Query
Use Test Payers in Sandbox
Attachments Submission FAQs
MEDICAL NETWORK ATTACHMENTS STATUS V1
Attachments Status V1 Getting Started
Use TraceId in your Query Path
API Example Attachments Status API
Attachments Status FAQs
MEDICAL NETWORK CLAIM RESPONSES AND REPORTS (ERA) API
Claim Responses and Reports V2 Getting Started
Available Claim Responses and Reports V2
SD and SF Reports Mapping
Claim File Retrieval and Retention Best Practices
API Example Claim Responses and Reports
Claim Responses and Reports - Request & Response
Associate Claims to ERA
Contents of 277 and 835 Reports
Convert 277 or 835 Report
EDI to JSON Translation
277 and 835 Reports Important Contents
Map 835s or 999s
Identify which Reports relate to which Patients
Know if a Claim is forwarded to Payer
Fetch Payer's Claim Number before Receiving ERA
Get Adjudication Message after Submitting a Claim
Get EOB Files for Payment Received from Payer
Get Exact Claim Details of Particular Claim
Payer Batch Totals Data File
Payer Report Data File
ServiceLines Array Record for a Dental Encounter
Translate a 277 EDI Claims Responses and Reports File to JSON
Translate an 835 EDI Claim Responses and Report File to JSON
Test Claims Responses and Reports Functionality in Sandbox
Use Convert Report 276, 277, 835
Delete Claims Responses and Reports Files from Mailbox
Claim Responses and Reports FAQs
DENTAL BENEFITS ADVISOR API
Change Log/Release Notes
MEDICAL NETWORK PAYERLIST V1
PayerList Getting Started
PayerList Filter and Sort
API Example PayerList
Request and Response
Download the PayerList to a CSV File
PayerList FAQs
Enhanced eligibility api v1
Onboarding
Getting Started
Change Log/Release Notes
Frequently Asked Questions
Troubleshooting and Support
Value-Added Features
Customer Callback Example API
PRIOR AUTHORIZATION API V1
Prior Authorization V1 Getting Started
Onboarding with Prior Authorization API
Understand the JSON-to-EDI Mapping
Inquiry Prior Authorization
Inquiry Request Body
Inquiry Response Body
Inquiry JSON-to-EDI API Contents
Inquiry Sandbox Test Response
Inquiry Sandbox Test Responses
Submission Prior Authorization
Submission Request Body
Submission Response Body
Submission JSON-to-EDI API Contents
Submission Sandbox Test Responses
Prior Authorization API FAQs
Prior Authorization Release Notes
MEDICAL NETWORK DENTAL ATTACHMENTS API
Dental Attachments Getting Started
Request Body Content
Response Body Content
Dental FAQs
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